Lesson 9:-
There are a number of injuries that involve the ear that can occur during football. Some of these require prompt management to ensure that they do not cause ongoing deformity of dysfunction.
Cauliflower ear: This term refers to a haematoma between the skin and perichondrium (also known as traumatic auricular haematoma). If not treated appropriately, this type of injury can lead to lifelong deformity. The haematoma can become fibrotic within two weeks.
Initial treatment involves the use of ice and compression. Definitive treatment involves aspiration of the haematoma followed by direct compression with blue-tack/silicon or collodion-soaked gauze. To aspirate the haematoma, use a 20 gauge needle (or similar). After this has been done, the blue-tack should be used to attempt to preserve the normal shape of the ear. The player should then be examined daily to check their progress and to ensure that there has not been any recurrence. There is a small risk of infection with S.aureus or pseudomonas.
Otitis externa: This condition is common among those who swim or who train frequently in a pool. While it is generally caused by a bacterial infection, it can also be caused by a fungal infection. Players most commonly present with a painful and itchy ear. There may also be a discharge and in some cases impaired hearing.
On examination, the canal appears erythematous and a discharge may be observed. Tragal compression or tugging classically causes the player pain.
Treatment involves the player avoiding rubbing, scratching or Q-tips. Keeping the ear dry and the use of topical alcohol, oil or antibiotic drops are also generally useful strategies. Keeping one’s head above the water while in the pool is a good preventative strategy while topical alcohol applied after swimming, effectively dries the canal and prevents recurrence.
Tympanic membrane rupture: This typically happens after a direct blow to the ear or head. The player most commonly presents with pain, reduced hearing and sometimes bleeding. The player should be assessed with an otoscope to define and document the injury (and the size of the injury).
The majority heal with conservative management over two weeks. Treatment might involve the following:
- try to avoid any topical eardrops (due to risk of ototoxicity);
- keep ear dry (be especially careful with soapy water as it is more likely to enter the canal due to a reduced water tension);
- oral antibiotics might be used (amoxicillin is a good choice);
- consider an ENT review when the defect is large.
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Jatin Tyagi 